Black market monkeys for medical research

 Monkeys used in medical research are supposed to come from carefully bred laboratory colonies, but the rising price has led to black markets, which is bad for both monkeys and for medical researchers. (And monkeys are useful for medical research because of their relatively close relation to humans, which makes for difficult conversations regardless of their source...)

The Guardian has the story:

$20,000 monkeys: inside the booming illicit trade for lab animals  by Phoebe Weston

"An international shortage of lab monkeys has driven up prices, incentivising a booming illicit trade. The problem risks undermining research, creating new pandemics, and fuelling wildlife trafficking. As the trade expands, a once-thriving species is now on the edge: in 2022, it was added to the IUCN list of endangered species. Some animal rights activists are calling to end the trade altogether.

"Long-tailed macaques are the most heavily traded primate species in the world, according to a paper published in September, and much of this is for laboratory research. The US National Association for Biological Research says non-human primates remain a critical resource for research, with about 70,000 monkeys imported a year to study infectious diseases, the brain and the creation of new drugs. Difficulty getting monkeys is compromising important research, Sacha says. Before the pandemic he was paying between $2,000 (£1,600) and $5,000 for an animal. Now, it’s about $20,000. “For a couple of years during lockdown it was near impossible to get them,” he says.

"He is not alone. Almost two-thirds of researchers struggled to find monkeys in 2021, according to a report from the US National Academies of Sciences, Engineering, and Medicine, which found that the supply of monkeys for research is at crisis point. According to an article in Science, the report is the “strongest government statement yet on the precarious state of monkey research”. A similar picture is coming from Europe, where a shortage of monkeys has resulted in some research being abandoned.

"Long-tailed macaques (the monkey most commonly used in medical research) are protected under international trade law and special permits are required to import the animals into the US.

"Laboratories need pathogen-free primates that are in good condition and so do not want monkeys that have been wild-caught. With prices so high, however, traffickers are incentivised to catch them in the wild and launder them in via established breeding colonies.

"For decades, China was the largest supplier, but it banned the wild animal trade in 2020 in light of the Covid pandemic. Demand for monkeys increased significantly in the following years, but supply did not. Cambodia has since significantly increased exports to plug the gap and tap into this increasingly lucrative market.

...

"Animal rights campaigners want the US government to end the “cruel trade”, saying it poses a significant threat to public health. The National Academies report says investing in non-animal “organ on a chip” technology could reduce overall demand.

"It also recommended that the US expand its domestic breeding facilities – which it can then regulate. Sacha says: “We shouldn’t be reliant on external countries for these animals that are really critical to our ability to test new therapeutics and vaccines and medicines.”

Drug addiction: not just opioids

 Consumption of addictive drugs seems to come in deadly cocktails these days, which is making interdiction of drugs, and treatment of addiction more complicated.

The NYT has the story:

‘A Monster’: Super Meth and Other Drugs Push Crisis Beyond Opioids. Millions of U.S. drug users now are addicted to several substances, not just opioids like fentanyl and heroin. The shift is making treatment far more difficult.  By Jan Hoffman

"The United States is in a new and perilous period in its battle against illicit drugs. The scourge is not only opioids, such as fentanyl, but a rapidly growing practice that the Centers for Disease Control and Prevention labels “polysubstance use.”

Over the last three years, studies of people addicted to opioids (a population estimated to be in the millions) have consistently shown that between 70 and 80 percent also take other illicit substances, a shift that is stymieing treatment efforts and confounding state, local and federal policies.

“It’s no longer an opioid epidemic,” said Dr. Cara Poland, an associate professor at the Michigan State University College of Human Medicine. “This is an addiction crisis.”

...

"The incursion of meth has been particularly problematic. Not only is there no approved medical treatment for meth addiction, but meth can also undercut the effectiveness of opioid addiction therapies. Meth explodes the pleasure receptors, but also induces paranoia and hallucinations, works like a slow acid on teeth and heart valves and can inflict long-lasting brain changes.

"The Biden administration has been pouring billions into opioid interventions and policing traffickers, but has otherwise lagged in keeping pace with the evolution of drug use. There has been comparatively little discussion about meth and cocaine, despite the fact that during the 12-month period ending in May 2023, over 34,000 deaths were attributed to methamphetamine and 28,000 to cocaine, according to provisional federal data.

...

"Like opioids, which originally came from the poppy, meth started out as a plant-based product, derived from the herb ephedra. Now, both drugs can be produced in bulk synthetically and cheaply. They each pack a potentially lethal, addictive wallop far stronger than their precursors."

Repugnant sales of art: deaccessioning, in Switzerland

 "Deaccessioning" is a repugnant transaction in the art world, in which it's often considered acceptable to sell art only to finance the purchase of other art, and not to keep a museum from going bankrupt.  I've written about this in the U.S. context, but it's an international phenomenon.

The NY Times has the story, from Switzerland:

Swiss Museum in Financial Straits Sells Three Cézannes for $53 Million. Museum Langmatt said the sales were necessary to keep its doors open. Critics had said they violated industry guidelines on when a museum should sell off parts of its collection.

"The Foundation Langmatt’s decision to sell the Cézannes earned wide criticism before the auction. The Swiss branch of the International Council of Museums, which said the sale was a clear breach of its guidelines for de-accessioning from museum collections, called for the paintings to be withdrawn.

Banks boycott sex workers even for legal kinds of sex work

 Repugnance isn't erased by legality. Workers in morally contested, repugnant markets may be boycotted by banks even when their work is legal.  Marijuana sellers in states where marijuana sales are legal run into this problem because Federal law still prohibits such sales, but sex workers in legal industries (video sex, porn) and even prostitution in Nevada often can't keep bank accounts, even personal (i.e. non-buisiness) accounts.

The NYT has the story:

Sex Workers Have Been Shunned by Banks, Even When Their Work Is Legal. Financial service companies often avoid what they deem high-risk industries like adult entertainment. When workers lose their accounts, they are left with few options.  By Tara Siegel Bernard

“Despite being a legal establishment, there is, of course, still a stigma attached to the work,” Ms. Cummins, 74, said from Wells, Nev., the only state where prostitution is legal in certain counties. “There is no bank in Nevada that will lend money to a brothel."

...

"Workers in sex-related industries — whether in a brothel or a strip club or selling sexually explicit videos online — often risk their safety and face social and employment discrimination. But a lesser-known struggle is that it’s often difficult to maintain a basic bank account and other financial relationships that most people take for granted.

...

"Financial institutions are responsible for monitoring the nation’s cash flow for potential criminal activities, including human trafficking and money laundering. In the process they’ve also become quasi-law enforcement, making life-altering calls on who can keep banking and who cannot, based on their own calculus about what kind of risk is worth taking.

But without bank accounts, people are unable to accomplish the most basic of financial tasks: collecting, spending and saving their earnings. Once banished from mainstream bank accounts and everyday financial apps Americans have come to rely on, sex workers are left with fewer, and often less attractive, options — turning to crypto, for example, or being forced to rely on others to hold their cash, opening them up to exploitation. 

Will divorce become legal in the Philippines?

  The NYT has the story:

‘Just Like Medicine’: A New Push for Divorce in a Nation Where It’s Illegal.  A campaign in the Philippines that frames divorce as a basic human right is gaining momentum, despite systemic and religious barriers.  By Sui-Lee Wee

"Thousands of people like Ms. Nepomuceno are trapped in long-dead marriages in the Philippines, the only country in the world, other than the Vatican, where divorce remains illegal. 

...

"Partly because of their growing numbers and plight, attitudes in the country, where nearly 80 percent of the population is Catholic, have changed. Surveys show that half of Filipinos now support divorce. Even the president has signaled openness to the idea, and the Philippines is the closest it has ever been to legalizing divorce.

"But the issue is far from settled. The powerful Catholic Church has deemed pro-divorce activism to be “irrational advocacy.” Conservative lawmakers remain steadfast in their opposition.

"This has prompted some in the legalization camp to frame divorce as a basic human right, like access to health care or education.

...

"In recent months, a Senate committee approved a bill on divorce for the first time in more than 30 years. The bill is now awaiting a second reading in the Senate, which lawmakers say could happen next year.

...

"Divorce has a complicated history in the Philippines. During the Spanish colonial era, divorce was banned, but legal separation was allowed under narrow conditions. Under American occupation, it was made legal, but only on the grounds of adultery and concubinage. The Japanese, who occupied the Philippines during World War II, expanded the divorce law, allowing more grounds for people to seek divorce.

"That changed after the enactment of the country’s Civil Code in 1950. But Muslim citizens, who make up 5 percent of the population, are allowed to divorce, because in 1977, Ferdinand E. Marcos, the president at the time, signed legislation allowing it.

...

"A decade ago, when the Philippine Congress passed legislation that gave people access to contraception, the clergy held protests and threatened to excommunicate lawmakers for supporting the bill. This time, said Edcel Lagman, a congressman who has pushed for both issues, church officials have been less vocal in its opposition."

Report From a Multidisciplinary Symposium on the Future of Living Kidney Donor Transplantation

 How might we increase the number of lifesaving transplants from living kidney donors? Might we one day be able to reward donors? And what might we do until then, while we wait for something that will eventually replace human organ transplantation?  Here's the published account of last year's symposium.

Thomas G. Peters, John J. Fung, Janet Radcliffe-Richards, Sally Satel, Alvin E. Roth, Frank McCormick, Martha Gershun, Arthur J. Matas, John P. Roberts, Josh Morrison, Glenn M. Chertow, Laurie D. Lee, Philip J. Held, and Akinlolu Ojo, “Report From a Multidisciplinary Symposium on the Future of Living Kidney Donor Transplantation,” Progress in Transplantation  (forthcoming), Online first, Nov 15, 2023 https://journals.sagepub.com/doi/full/10.1177/15269248231212911  (pdf here).

Abstract: Virtually all clinicians agree that living donor renal transplantation is the optimal treatment for permanent loss of kidney function. Yet, living donor kidney transplantation has not grown in the United States for more than 2 decades. A virtual symposium gathered experts to examine this shortcoming and to stimulate and clarify issues salient to improving living donation. The ethical principles of rewarding kidney donors and the limits of altruism as the exclusive compelling stimulus for donation were emphasized. Concepts that donor incentives could save up to 40 000 lives annually and considerable taxpayer dollars were examined, and survey data confirmed voter support for donor compensation. Objections to rewarding donors were also presented. Living donor kidney exchanges and limited numbers of deceased donor kidneys were reviewed. Discussants found consensus that attempts to increase living donation should include removing artificial barriers in donor evaluation, expansion of living donor chains, affirming the safety of live kidney donation, and assurance that donors incur no expense. If the current legal and practice standards persist, living kidney donation will fail to achieve its true potential to save lives.

#######

Links to videos of the symposium presentations are here:

Friday, July 15, 2022

The Future of Living Donor Kidney Transplantation (videos)

The EU proposes strengthening bans on compensating donors of Substances of Human Origin (SoHOs)--op-ed in VoxEU by Ockenfels and Roth

 The EU has proposed a strengthening of European prohibitions against compensating donors of "substances of human origin" (SoHOs).  Here's an op-ed in VoxEU considering how that might effect their supply.

Consequences of unpaid blood plasma donations, by Axel Ockenfels and  Alvin Roth / 4 Nov 2023

"The European Commission is considering new ways to regulate the ‘substances of human origin’ – including blood, plasma, and cells – used in medical procedures from transfusions and transplants to assisted reproduction. This column argues that such legislation jeopardises the interests of both donors and recipients. While sympathetic to the intentions behind the proposals – which aim to ensure that donations are voluntary and to protect financially disadvantaged donors – the authors believe such rules overlook the effects on donors, on the supply of such substances, and on the health of those who need them.

"Largely unnoticed by the general public, the European Commission and the European Parliament’s Health Committee have been drafting new rules to regulate the use of ‘substances of human origin’ (SoHO), such as blood, plasma, and cells (Iraola 2023, European Parliament 2023). These substances are used in life-saving medical procedures ranging from transfusions and transplants to assisted reproduction. Central to this legislative initiative is the proposal to ban financial incentives for donors and to limit compensation to covering the actual costs incurred during the donation process. The goal is to ensure that donations are voluntary and altruistic. The initiative aims to protect the financially disadvantaged from undue pressure and prevent potential misrepresentation of medical histories due to financial incentives. While the intention is noble, the proposal warrants critical analysis as it may overlook the detrimental effects on donors themselves, on the overall supply of SoHOs, and consequently on the health, wellbeing, and even the lives of those who need them. We illustrate this in the context of blood plasma donation.

"Over half a century ago, Richard Titmuss (1971) conjectured that financial incentives to donate blood could compromise the safety and overall supply. This made sense in the 1970s, when tests for pathogens in the blood supply were not yet developed. But Titmuss’ conjecture permeated policy guidelines worldwide, despite mounting evidence to the contrary. Although more evidence is needed, a review published by Science (Lacetera et al. 2013; see also Macis and Lacetera 2008, Bowles 2016), which looked at the evidence available more than 40 years after Titmuss’ conjecture, concluded that the statistically sound, field-based evidence from large, representative samples is largely inconsistent with his predictions.

"Getting the facts right is important because, at least where blood plasma is concerned, the volunteer system has failed to meet demand (Slonim et al. 2014). There is a severe and growing global shortage of blood plasma. While many countries are unwilling to pay donors at home, they are willing to pay for blood plasma obtained from donors abroad. The US, which allows payment to plasma donors, is responsible for 70% of the world’s plasma supply and is also a major supplier to the EU, which must import about 40% of its total plasma needs. Together with other countries that allow some form of payment for plasma donations – including EU member states Germany, Austria, Hungary, and the Czech Republic – they account for nearly 90% of the total supply (Jaworski 2020, 2023). Based on what we know from controlled studies and from experiences with previous policy changes, a ban on paid donation in the EU will reduce the amount of plasma supplied from EU members, prompting further attempts to circumvent the regulation by importing even more plasma from countries where payment is legal. At the same time, a ban will contribute to the global shortage of plasma, further driving up the price and making it increasingly unaffordable for low-income countries (Asamoah-Akuoko et al. 2023). In the 1970s, it may have been reasonable to worry that encouraging paid donation would lead to a flow of blood plasma from poor nations to rich ones. That is not what we are in fact seeing. Instead, plasma supplies from the US and Europe save lives around the world.

"In other areas, society generally recognises the need for fair compensation for services provided, especially when they involve discomfort or risk. After all, it is no fun having someone stick a needle in your arm to extract blood. This consensus cuts across a range of services and professions – including nursing, firefighting, and mining – occupations, most people would agree, that should be well rewarded for the risk involved and value to society. To rely solely on altruism in such areas would be exploitative and would eventually lead to a collapse in provision. Indeed, to protect individuals from exploitation, labour laws around the world have introduced minimum compensation requirements rather than caps on earnings. In addition, payment bans on donors, even if they’re intended to protect against undue inducements, raise concerns about price-fixing to the benefit of non-donors in the blood plasma market. In a related case, limits on payment to egg donors have been successfully challenged in US courts. 1

"In addition, policy decisions affecting vital supplies such as blood plasma should be based on a broad discourse that includes diverse perspectives and motivations. Ethical judgements often differ, both among experts and between professionals and the general public, so communication is essential (e.g. Roth and Wang 2020, Ambuehl and Ockenfels 2017). Payment for blood plasma donations is an example. We (the authors of this article) are from the US and Germany, countries that currently allow payment for blood plasma donations while most other countries prohibit payment. On the other hand, prostitution is legal in Germany but surrogacy is not, while the opposite is true in most of the US. And while Germany currently prohibits kidney exchange on ethical grounds, other countries – including the US, the UK, and the Netherlands – operate some of the largest kidney exchanges in the world and promote kidney exchange on ethical grounds.

"The general public does not always share the sentiments that health professionals find important (e.g. Lacetera et al. 2016). This tendency is probably not due to professionals being less cognitively biased. In all areas where the question has been studied, experts such as financial advisers, CEOs, elected politicians, economists, philosophers, and doctors are just as susceptible to cognitive bias as ordinary citizens (e.g. Ambuehl et al. 2021, 2023). Recognising the similarities and differences between professional and popular judgements, and how ethical judgements are affected by geography, time, and context, allows for a more constructive and effective search for the best policy options.

"In our view, the dangers of undersupply of critical medical substances, of inequitable compensation (particularly for financially disadvantaged donors), and of circumvention of regulation by sourcing these substances from other countries (where the EU has no influence on the rules for monitoring compensation to protect donors from harm) are at least as significant as those arising from overpayment. Carefully designed transactional mechanisms may also help to respect ethical boundaries while ensuring adequate supply. Advances in medical and communication technologies, such as viral detection tests, can effectively monitor blood quality and ensure the safety and integrity of the entire donation process – including the deferral of high-risk donors and those for whom donating is a risk to their health – without prohibiting payment to donors. Even if it is ultimately decided that payments should be banned, there are innovations in the rules governing blood donation that have been proposed, implemented, and tested that would improve the balance between blood supply and demand within the constraints of volunteerism; non-price signals, for instance, can work within current social and ethical constraints.

"As the EU deliberates on this legislation, it is imperative to adopt a balanced, empirically sound, and research-backed approach that considers multiple effects and promotes policies to safeguard the interests of both donors and recipients.

References

Asamoah-Akuoko, L et al. (2023), “The status of blood supply in sub-Saharan Africa: barriers and health impact”, The Lancet 402(10398): 274–76.

Ambuehl, S and A Ockenfels (2017), “The ethics of incentivizing the uninformed: A vignette study”, American Economic Review Papers & Proceedings 107(5), 91–95.

Ambuehl, S, A Ockenfels and A E Roth (2020), “Payment in challenge studies from an economics perspective”, Journal of Medical Ethics 46(12): 831–32.

Ambuehl, S, S Blesse, P Doerrenberg, C Feldhaus and A Ockenfels (2023), “Politicians’ social welfare criteria: An experiment with German legislators”, University of Cologne, working paper.

Ambuehl, S, D Bernheim and A Ockenfels (2021), “What motivates paternalism? An experimental study”, American Economic Review 111(3): 787–830.

Bowles S (2016), “Moral sentiments and material interests: When economic incentives crowd in social preferences”, VoxEU.org, 26 May.

European Parliament (2023), “Donations and treatments: new safety rules for substances of human origin”, press release, 12 September.

Iraola, M (2023), “EU Parliament approves text on donation of substances of human origin”, Euractiv, 12 September.

Jaworski, P (2020), “Bloody well pay them. The case for Voluntary Remunerated Plasma Collections”, Niskanen Center.

Jaworski, P (2023), “The E.U. Doesn’t Want People To Sell Their Plasma, and It Doesn’t Care How Many Patients That Hurts”, Reason, 20 September.

Lacetera, N, M Macis and R Slonim (2013), “Economic rewards to motivate blood donation”, Science 340(6135): 927–28.

Lacetera, N, M Macis and J Elias (2016), “Understanding moral repugnance: The case of the US market for kidney transplantation”, VoxEU.org, 15 October.

Macis M and N Lacetera (2008), “Incentives for altruism? The case of blood donations”, VoxEU.org, 4 November.

Roth, A E (2007), “Repugnance as a constraint on markets”, Journal of Economic Perspectives 21(3): 37–58.

Roth A E and S W Wang (2020), “Popular repugnance contrasts with legal bans on controversial markets”, Proc Natl Acad Sci USA 117(33): 19792–8.

Slonim R, C Wang and E Garbarino (2014), “The Market for Blood”, Journal of Economic Perspectives 28(2): 177–96.

Titmuss, R M (1971), The Gift Relationship, London: Allen and Unwin.

Footnotes: 1. Kamakahi v. American Society for Reproductive Medicine, US District Court Northern District of California, Case 3:11-cv-01781-JCS, 2016.

US halts export of most civilian firearms and ammunition for 90 days.

One of many things that makes the U.S. unusual is the Constitutionally protected status of gun ownership and gun sales here.  Guns being guns, this comes with some built in negative externalities that we struggle to contain.  But we also export guns, to legal markets in other countries (as well as sometimes to illegal ones)  and this can impose negative externalities elsewhere.   Apparently the Commerce Department is reviewing the situation.

 The Guardian has the story (from the Reuters news service):

US halts export of most civilian firearms and ammunition for 90 days. Commerce department cites foreign policy interests and says it will review ‘risk of firearms’ diverted’ to ‘violate human rights’

"The US has stopped issuing export licenses for most civilian firearms and ammunition for 90 days for all non-governmental users, the commerce department said on Friday, citing national security and foreign policy interests.

"The commerce department did not provide further details for the pause, which also includes shotguns and optical sights, but said an urgent review will assess the “risk of firearms being diverted to entities or activities that promote regional instability, violate human rights, or fuel criminal activities”.

##########

Earlier:

Sunday, January 22, 2023

The trade in guns and drugs on the Mexico-US border

Transcript withholding by colleges and universities to be regulated

 Inside Higher Ed has the story:

U.S. Bans Most Withholding of Transcripts. The Education Department strengthens its oversight of institutions with a sweeping set of rules finalized this week.  By  Katherine Knott

"Afederal policy change could give thousands of students access to transcripts and academic credits their colleges have withheld because they owed the institutions money. The new rule, part of a broad package of regulations the U.S. Education Department unveiled Tuesday, could amount to a national ban on the practice of transcript withholding, experts say.

Institutions sometimes withhold transcripts to force a student to pay a balance on their account. Without their transcripts, students often can’t continue their education elsewhere without starting over, and they cannot apply for certain jobs. The practice has come under increasing scrutiny in recent years, with dozens of states enacting their own bans.

The department’s new rule is broader than what the agency proposed in May and would prevent a college or university from withholding a student’s transcript for terms in which a student received federal financial aid and paid off the balance for the term. Research from Ithaka S+R, a research and consulting group, has shown that about six million students have what are called stranded credits because of transcript withholding.

...

“For a large number of students and former students who are impacted by transcript withholding, this should solve a significant portion of the problem,” said Edward Conroy, a policy fellow at New America, a left-leaning think tank. “Because in most cases, even when former students owe larger debts, nobody owes a debt for the entirety of their degree. It might be for their last semester or something like that.”

Magic mushrooms as therapy

 The legal use of psychedelics in therapy is growing.

The NYT has the story:

A New Era of Psychedelics in Oregon. The state has pioneered a therapeutic market for psychedelic mushrooms. Researchers are watching with a mix of excitement and unease.  By Mike Baker

"Stigmatized in law and medicine for the past half-century, psychedelics are in the midst of a sudden revival, with a growing body of research suggesting that the mind-altering compounds could upend psychiatric care. Governments in several places have cautiously started to open access, and as Oregon voters approved a broad drug decriminalization plan in 2020, they also backed an initiative to allow the use of mushrooms as therapy.

...

"For those who have long worked on psychedelics research, the sudden expansion in access in Oregon and Colorado, along with cities like Denver, Detroit, Minneapolis and Washington, D.C., have prompted a mix of elation and trepidation. Oregon has settled on a middle-of-the-road approach, requiring neither a doctor’s supervision nor a specific medical diagnosis, but providing for strict oversight of supply and use.

...

"While some form of legalized marijuana is authorized in all but 12 states, creating a huge, multi-billion-dollar industry, the psilocybin market remains small, with an uncertain financial outlook for those entering it. Only five businesses are approved to manufacture the therapeutic-use fungi in Oregon, with 13 sites approved to host dosing sessions.

...

"Officials in other states are watching what happens in Oregon. Voters in Colorado approved a measure last year to decriminalize psilocybin and to set the state on the path to a legal therapeutic market. In other states, including Texas, lawmakers have authorized studies of psilocybin for treating ailments such as PTSD. The F.D.A. has granted the drug “breakthrough therapy” status, which allows for expedited review of substances that have demonstrated substantial promise.

"But there is uncertainty about the best path forward. California lawmakers approved a bill this year to decriminalize several hallucinogens, but Gov. Gavin Newsom vetoed the measure, saying the state needs to first set up regulated treatment guidelines. The American Psychiatric Association has urged caution, saying treatments should be limited to research studies for now."

Scientists deliberately gave women Zika--challenge trials for diseases whose incidence has dropped too far for conventional clinical trials

 Nature has the story (despite the somewhat inflammatory headline).

Scientists deliberately gave women Zika — here’s why. ‘Human challenge’ results suggest that such trials could be used to test vaccines when Zika incidence is low.  by Mariana Lenharo, Nature, 21 October 2023

"For the first time, scientists have deliberately infected people with Zika virus to learn whether such a strategy could help to test vaccines against the pathogen.

The virus can cause severe birth abnormalities in babies born to parents infected during pregnancy. It also has been associated with neurological problems in adults, although those cases are rare. But infected study participants had only mild symptoms, and none became pregnant during or immediately after the trial. The results raise hopes that ‘human challenge’ programmes — in which volunteers are exposed to a pathogen in a controlled setting — could make it feasible to test vaccines at a time when Zika incidence is low.

“This is a great scientific gain in terms of the development of a vaccine,” said Rafael Franca, an immunologist at the Oswaldo Cruz Foundation in Ribeirão Preto, Brazil. The results are scheduled to be presented today at the annual meeting of the American Society of Tropical Medicine and Hygiene in Chicago, Illinois.

...

"In 2022, after a long process to address ethical concerns around the study, Durbin and her team recruited 28 healthy women, aged 18 to 40, who were neither pregnant nor lactating. All agreed to be admitted to a research facility and remain there until they were no longer infectious; they stayed at the unit for 9 to 16 days. They were tested for pregnancy several times before receiving the virus, to avoid the risk of congenital problems associated with Zika, and were counselled to use birth control for at least two months after the study.

Hope for smaller trials

The researchers injected 20 participants with one of two strains of Zika virus and eight with placebo. All of the participants who received the virus were infected; of those, 95% developed a rash — a common symptom of Zika — and 65% had joint pain. None of the placebo recipients had those symptoms.

Durbin says the findings indicate that the two strains of Zika administered in the trial can be safely and effectively used to infect participants in a Zika vaccine trial. She estimates that the controlled human infection model could be used in a phase III clinical trial for vaccine efficacy with as few as 50 to 100 participants. “With the challenge model, where you have 100% of infections, you could get an efficacy result with many fewer people” than in a conventional trial, says Durbin.

...

The new study represents a turnaround in the thinking about challenge trials. In early 2017, a report by researchers convened by the National Institute of Allergy and Infectious Diseases and the Walter Reed Army Institute of Research concluded that the risks of a human-infection study for Zika, at that time, surpassed the potential benefits.

...

But “from that time to now, we learnt a lot,” says Palacios. “Now we know that the risk of the virus being transmitted to another person through sexual relationships is limited and something that can be controlled,” he says. And regulators have signalled that they might consider data from human challenge trials in vaccine development, “in particular for those diseases that don’t have enough incidence to test in the field.”

Despite the low number of Zika cases, researchers say that it’s important to continue the efforts to develop a vaccine, because the virus might make a comeback. “Infections are much lower than they were during the epidemic in 2016. However, they are still occurring,” says Neil French, an infectious-disease specialist at the University of Liverpool, UK, who is involved in a Zika vaccine-development project. “The justification for a vaccine remains strong.”

Markets, Virtues and Ethics

 Do markets complement virtues, or sideline them?  Here's another entry into that discussion.

Reese, A., Pies, I. Solidarity Among Strangers During Natural Disasters: How Economic Insights May Improve Our Understanding of Virtues. J Ethics (2023). https://doi.org/10.1007/s10892-023-09460-7

"Abstract: The renaissance of Aristotelian virtue ethics has produced an extensive philosophical literature that criticizes markets for a lack of virtues. Drawing on Michael Sandel’s virtue-ethical critique of price gouging during natural disasters, we (1) identify and clarify serious misunderstandings in recurring price-gouging debates between virtue-ethical critics and economists. Subsequently, (2) we respond to Sandel’s call for interdisciplinary dialogue. However, instead of solely calling on economics to embrace insights from virtue ethics, we prefer a two-sided version of interdisciplinary dialogue and argue that virtue ethics should embrace economic insights. In particular, we argue that if virtue ethics is to preserve its social relevance under modern conditions, it should re-conceptualize its notion of virtue and re-evaluate the self-interested but effective—and in this sense solidary—help among strangers via markets as virtuous rather than devaluate it as greed, that is, as vicious price gouging.

...

"Most forms of virtue ethics share a central concern for the moral character of a person, the development of excellence, and an emphasis on avoiding vices and pursuing virtues. This means that in essence, the virtue ethics perspective focuses on good intentions and intended consequences. In contrast, modern economics fosters a systems approach to situational incentives and thus shifts the perspective to focus on the unintended consequences of intentional actions.

...

" Roth (2007) acknowledges repugnance and other kinds of assumed moral inappropriateness as real constraints on market design. He takes moral feelings seriously and proposes market arrangements that do not evoke such feelings. For example, many people experience a feeling of unease with the idea of being able to buy and sell kidneys, which is currently possible for Iranians in the Islamic Republic of Iran. By designing in-kind kidney exchanges, Roth has shown ways to facilitate market transactions that operate entirely without money and, as such, do not evoke repugnant reactions (Leider and Roth 2010; Roth 2016). Surely, there are still too many people desperately waiting for a kidney. However, the implementation of in-kind exchanges has saved lives. It has helped a significant number of people obtain a kidney that would have obtained none without such a system. In line with Roth, we take the virtue argument seriously. However, we choose a longer time horizon where the assumed moral inappropriateness is no longer a given constraint on market design but becomes, at least in principle, a variable.

...

"Sandel insists on deciding case by case whether we should give the virtue of (probably less effective) selfless help precedence over the assumed repugnance of (probably more effective) self-interested help via markets, or vice versa.

...

"Reassessments of social practices are not uncommon throughout history. Most people today perceive the practices of charging interest rates, dueling, and paying opera singers for their performance differently than their ancestors. 

Repugnance is hard to predict

Widespread repugnance, or its absence, is hard to predict.  Why do the U.S. and western Europe have almost opposite positions on the legality of surrogacy and prostitution for example? 

Here's a paper that carefully looked for, and failed to find evidence of a repugnance reaction from consumers about a scandal involving a company spokesperson (but unrelated to the company's business).

The Role of Repugnance in Markets: How the Jared Fogle Scandal Affected Patronage of Subway  by John Cawley, Julia Eddelbuettel, Scott Cunningham, Matthew D. Eisenberg, Alan D. Mathios & Rosemary J. Avery NBER WORKING PAPER 31782 DOI 10.3386/w31782  October 2023

Economics has long studied how consumers respond to the disclosure of information about firms. We study a case in which the disclosed information is unrelated to the product or firm leadership, but which could still potentially affect consumer patronage through the mechanism of repugnance, as described in Roth (2007). The information in this case concerns the arrest of Jared Fogle, the advertising pitchman for the Subway sandwich franchise, who was arrested in 2015 on charges of sex with a minor and child pornography. We study how the disclosure of this information, which was widely covered in the media, affected patronage of Subway. We estimate synthetic control models using data from a large nationwide survey of consumers regarding the restaurants they patronize. Despite the close and long-standing association of Jared Fogle with Subway, and heavy publicity of his crimes, we consistently fail to detect any effect of the Jared Fogle scandal on the probability of visiting a Subway restaurant. These results contrast with past studies of negative information disclosure, which tend to find negative impacts on sales, revenue, or stock price of the relevant companies. The absence of an effect in this case suggests that repugnance did not drive demand, and that consumers largely separated the offenses of a symbol of the firm from the products of the firm.

Blood use in the U.S., in JAMA

 Here are a collection of articles, some of which suggest that we may in the not so distant future face a shortage of whole blood in the U.S., the need for which is so far filled by uncompensated donors (unlike the need for plasma, which is presently filled by compensated donors...).  One issue is that apparently ambulance companies aren't easily compensated for beginning transfusion on the way to the hospital, which could save lives.

Original Investigation Caring for the Critically Ill Patient Red Blood Cell Transfusion in the Intensive Care Unit Senta Jorinde Raasveld, MD; Sanne de Bruin, MD, PhD; Merijn C. Reuland, MD; et al. "RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices." Editorial: Precision in Transfusion Medicine ; Matthew D. Neal, MD; Beverley J. Hunt, MD "blood transfusion practice has come a long way, but further efforts toward precision medicine are required to ensure that patients receive the most effective components. These products should be matched to patients as individuals who have unique antigens and a variable host response, and how to use the appropriate blood components in different clinical settings must be understood." Caring for the Critically Ill Patient Small-Volume Blood Collection Tubes to Reduce Transfusions in Intensive Care: The STRATUS Randomized Clinical Trial Deborah M. Siegal, MD; Emilie P. Belley-Côté, MD, PhD; Shun Fu Lee, PhD; et al. Caring for the Critically Ill Patient Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial Jan O. Jansen, PhD; Jemma Hudson, PhD; Claire Cochran, MSc; et al. Editorial: Contemporary Adjuncts to Hemorrhage Control ; Samuel A. Tisherman, MD; Megan L. Brenner, MD Caring for the Critically Ill Patient Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial Ross Davenport, PhD; Nicola Curry, MD; Erin E. Fox, PhD; et al. Editorial: Contemporary Adjuncts to Hemorrhage Control; Samuel A. Tisherman, MD; Megan L. Brenner, MD Special Communication Red Blood Cell Transfusion: 2023 AABB International Guidelines Jeffrey L. Carson, MD; Simon J. Stanworth, MD, DPhil; Gordon Guyatt, MD; et al. Earn CME credit Viewpoint From Product to Patient—Transfusion and Patient Blood Management Matthew A. Warner, MD; Linda Shore-Lesserson, MD; Carolyn Burns, MD "Recent years have also exposed vulnerabilities in blood inventories. As the most prominent example, the COVID-19 pandemic led to cancellations of many community-based and mobile blood collections, culminating in the declaration of a national blood crisis by the American Red Cross for the first time in history. In response, the American Medical Association, in partnership with the American Hospital Association and American Nurses Association, issued a joint statement in January 2022 describing the worst blood shortage in more than a decade and urging blood donation from all eligible persons. Not long after, the AABB, in collaboration with 17 leading US health care and blood collection organizations, launched the Alliance for a Strong Blood Supply to track and coordinate information and public communications about blood inventories and explore mechanisms to improve blood supply resilience." The Bloody Transfusion Problem John B. Holcomb, MD; William K. Hoots, MD; Travis M. Polk, MD "Preventable death after injury is a national crisis. Worldwide, injury accounts for more deaths than malaria, tuberculosis, and HIV combined and is increasing.1 Trauma is largely a condition of young people and is the leading cause of life-years lost between 1 and 75 years of age, and costs to the US are estimated at $4.2 trillion a year.2 As is always the case, lessons learned on recent battlefields have improved civilian care, and the most impactful intervention has been the increased use of blood products as a primary resuscitation fluid. "During the past decade several large, prospective, multicenter, randomized, federally funded studies have improved outcomes and changed practice.3,4 Transfusing blood as early as possible to patients with hemorrhagic shock saves lives, and fewer patients die from exsanguination when receiving a balanced transfusion of platelets, red blood cells, and plasma or whole blood. This is true in the hospital but is especially so in the prehospital setting, where blood products decrease mortality from 33% to 23%.4 When all indicated blood products are available and given early, deaths due to hemorrhage decrease and care is cost-effective. However, of the 2045 hospitals to which the American Red Cross supplied blood components in 2019, 33% did not routinely have platelets ready to transfuse to bleeding patients, and more than 78% of those hospitals are in a rural setting.4 Emergency medical services (EMS) agencies and hospitals that do not have all blood products immediately available cannot provide optimal care. Unfortunately, the blood products required to save lives are not uniformly available to all persons, and implementation of these proven lifesaving interventions is uneven, largely because of supply and policy reasons. "To remedy this disparity, we believe there are 3 significant hurdles to overcome: (1) enabling a reliable strategy for insuring an adequate blood product supply by developing new shelf-stable blood products and by providing greater financial support for donor blood collection and processing; (2) insuring adequate reimbursement for current and new blood products in the hospital setting and removing the limitation of prehospital provider scope of practice and ability to bill for all blood products; and (3) sustaining consistent and appropriate research funding for trauma studies of hemorrhagic shock in both pediatric and adult populations.  ... "Blood collection and processing centers are operating at a loss because remuneration has not kept pace with ever-increasing costs of regulatory required infectious disease testing. ... "More than 55 000 additional donors will be required for just the prehospital blood program implementation.6 Increasing the blood supply will require novel solutions combining remuneration for donors, increased reimbursement for blood collection centers, modern efforts to recruit younger donors, and streamlined regulatory and financial reimbursement pathways for new blood products that are shelf stable at room temperature for years. ... "scope of practice, reimbursement barriers, and the inability to bill for transfusions provided in air or ground ambulances are significant obstacles to the widespread availability of prehospital blood programs." Redefining Blood Donation—Path to Inclusivity and Safety Pampee P. Young, MD, PhD; Paula Saa, PhD Video: Gay and Bisexual Men Can Now Donate Blood—Why This Matters "The journey to establish equitable blood donation policies can be likened to the myth of Theseus navigating the Labyrinth. Just as Theseus ventured into the complex maze to save Athenians from the Minotaur, the blood industry has been navigating the intricacies of research, regulation, and public sentiments to secure a safe blood supply and equitable policies. With the advancements in testing and the changing policies as our guiding thread, we are dedicated to ensuring fairness, equality, and safety, led by evidence and a deep commitment to humanity." Editorial Precision in Transfusion Medicine Matthew D. Neal, MD; Beverley J. Hunt, MD Contemporary Adjuncts to Hemorrhage Control Samuel A. Tisherman, MD; Megan L. Brenner, MD Medical News & Perspectives Could Universal Donor Blood Be Made in the Laboratory? Bridget M. Kuehn "In the face of chronic national and international blood supply shortages, scientists are renewing efforts to achieve the holy grail of transfusion—laboratory-made universal donor blood." JAMA Revisited The Status of Blood Transfusion "Originally Published September 29, 1923 | JAMA. 1923;81(13):1114- 1115." JAMA Patient Page Blood Donation Kristin Walter, MD, MS Video: Gay and Bisexual Men Can Now Donate Blood—Why This Matters Video Gay and Bisexual Men Can Now Donate Blood—Why This Matters